President’s Medicaid Numbers: Fuzzy Math?

With just five weeks left until the end of the Affordable Care Act’s open enrollment period, President Obama continues to tout the benefits of his signature legislation. Last week, the president said 7 million Americans were able to gain access to Medicaid for the first time thanks to law. But some say the math doesn’t add up.

"We’ve got close to 7 million Americans who have access to health care for the first time because of Medicaid expansion," Obama told those in attendance at the Democratic Governor's Association dinner on Feb. 20.

The eligibility requirements for the government-run program, which provides free or low-cost health coverage to low-income Americans, was expanded under the ACA to include those making up to 138% of the federal poverty level, which is about $15,850 a year.

The law leaves it up to states to decide whether or not to expand their Medicaid programs; 25 states and the District of Columbia have expand their programs. By opting in, the government pays 100% of the expansion, the funding drops to 90% by 2020.

The nonpartisan Congressional Budget Office says the number of Americans on Medicaid will hit 8 million this year, which the Post points out will include people who were previously eligible for coverage. The article also cites health consulting firm Avalere’s latest figures which estimate that 1.1 million to 1.8 million Americans on Medicaid could be attributed to the program’s expansion under the ACA.

The president’s statement is in line with similar concerns over how many Americans are receiving health insurance for the first time on private exchanges due to the reform, says Paul Howard, director of the Center for Medical Progress at the Manhattan Institute. HHS reported on Tuesday that 4 million people had enrolled in plans via both state and federal exchanges, but it is not clear how many of these people have paid their first month’s premiums.

Under the ACA, every individual in the country has to have health insurance by the end of open enrollment on April 1, or they will face a fine of $95 or 1% of their annual income.

“The president and his allies want to drum up enrollment as much as possible,” Howard says. “But the true number of first-timers is much smaller than what he is saying. There are far less ‘new insured’ due to the ACA Medicaid expansion, and we are seeing the same thing in the private insurance market as well.”

Howard says many consumers are transferring from pre-ACA plans to ACA-compliant plans. More than 6 million Americans had their coverage cancelled after the rollout of the ACA because the plans didn’t meet standards outlined in the law. The ACA mandates every health insurance plan cover 10 essential health benefits, including mental health services, prescription drug benefits and maternity care.

“It’s hard to tease out who is getting insurance for the first time under the ACA,” Howard says. “Insurers should be able to tell if they are transferring someone from a pre-ACA plan to an ACA-compliant plan.”

As the rollout was so famously “fumbled” at the launch of open enrollment season on Oct. 1, Howard says ahead of mid-term elections, Democrats are trying to find success stories to highlight.

“The rollout was so badly handled, the president has to find as many bright spots as possible.”